Chest Discomfort and Numbness: Cardiovascular Symptoms

Chest tightness with mild pain, soreness in the cervical and sacral regions, and numbness in the hands and feet?

Hello, Doctor.
Around the end of March, I started experiencing discomfort.
Previously, in mid-March, I had an episode of chest tightness and pain on the right side after work, which improved with rest.
However, by late March to early April, the discomfort began again from the right side, with noticeable tenderness upon pressure.
In April, I visited a cardiologist who arranged for an X-ray and an electrocardiogram, informing me that there were no issues but suspected inflammation in a certain area.
I was prescribed anti-inflammatory medication, which did not help.
Subsequently, the chest tightness and pain began to shift to the center and left side, with less noticeable tenderness upon pressure.
On April 11, I consulted a pulmonologist who ordered another X-ray and a forced vital capacity test.
From April 11 to April 13, I felt discomfort in the center-left of my chest.
On April 14, I experienced mild numbness in my left arm near the armpit, along with soreness in my tailbone and cervical spine, and slight tightness in the left chest.
On April 15, the left chest tightness persisted.
On April 16, while driving, I felt tightness in the left chest and pain in the left abdomen, which improved with rest but was noticeable throughout the day.
On April 17, I had mild numbness in my left ring and little fingers, along with cervical spine soreness.
On April 18, I returned to the pulmonologist, and both the X-ray and forced vital capacity tests were normal.
Since I was still concerned, I also consulted a cardiologist that day and had blood drawn, with results expected in early May.
On April 19, I experienced cervical spine soreness and mild numbness in both hands.
On April 20, the cervical soreness continued.
On April 21, I had numbness in my hands and feet, with the feet being more pronounced.
On April 22, I felt tingling in my feet, but it wasn't numb yet.
On April 23, the cervical soreness persisted.
The symptoms tend to be more pronounced during work hours, while they improve somewhat on weekends or after work.
In the following days, my chest condition improved significantly, mainly involving cervical soreness and mild numbness in my hands and feet.
Occasionally, I experience tightness and a tingling sensation near the armpit area.
The cervical soreness is noticeable at the back of my neck where there is a protruding bone, and the tailbone soreness is felt when sitting down.
I am unsure of the cause of these symptoms, so I have been keeping a daily record of my condition while waiting for my follow-up appointment.
I am very concerned that I might have symptoms of aortic dissection or other serious conditions.
I would like to ask for your opinion on my symptoms or recommendations on which specialty to consult and what tests to undergo.
Thank you for your attention.

Wuzhong, 30~39 year old female. Ask Date: 2023/04/23

Dr. He Dongjin reply Cardiology

Hello, the neurology examination regarding cervical artery dissection is not related to you.
The symptoms are completely different, and aortic dissection is an emergency that would not be delayed for so long.
Changhua Hospital cares about you.

Reply Date: 2023/04/23

More Info

Understanding cardiovascular symptoms, particularly chest discomfort and numbness, is crucial for timely diagnosis and treatment. Your symptoms, which began with right-sided chest discomfort and have since evolved to include left-sided discomfort, numbness in the arms, and neck pain, warrant careful evaluation.

Initial Evaluation of Symptoms
1. Chest Pain Characteristics: The nature of your chest pain is important. You mentioned that the pain was initially localized to the right side and then shifted to the center and left side. This shifting pain can sometimes indicate musculoskeletal issues, especially if it is reproducible with palpation. However, it can also be associated with cardiac conditions, particularly if it is accompanied by other symptoms like numbness or discomfort radiating to the arms.

2. Associated Symptoms: The numbness in your left arm and fingers, along with neck pain, raises concerns that could be related to nerve compression or vascular issues. The fact that your symptoms improve with rest and worsen with activity could suggest a musculoskeletal origin, but it is essential to rule out cardiac causes.

3. Risk Factors: Your age, medical history, and lifestyle factors (such as smoking, diabetes, or family history of heart disease) play a significant role in assessing your risk for cardiovascular diseases. If you have any of these risk factors, it increases the importance of thorough evaluation.

Diagnostic Workup
Given your symptoms and the progression you've described, a comprehensive evaluation is warranted. Here are some recommended steps:
1. Cardiac Evaluation: Since you have already undergone an electrocardiogram (ECG) and chest X-ray, it would be prudent to follow up with a cardiologist. They may recommend further testing, such as:
- Echocardiogram: To assess heart function and structure.

- Stress Testing: To evaluate how your heart performs under physical stress.

- Coronary Angiography: If there is a suspicion of coronary artery disease, this invasive test can provide detailed images of the heart's blood vessels.

2. Neurological Assessment: Given the numbness in your arms and fingers, a consultation with a neurologist may be beneficial. They might suggest:
- Nerve Conduction Studies: To evaluate for conditions like carpal tunnel syndrome or cervical radiculopathy.

- MRI of the Cervical Spine: To check for any disc herniation or spinal stenosis that could be causing nerve compression.

3. Musculoskeletal Evaluation: If the pain is determined to be musculoskeletal, physical therapy may be recommended to strengthen and stabilize the neck and shoulder areas.

Monitoring and Follow-Up
- Symptom Diary: Continue to keep a detailed record of your symptoms, noting their frequency, duration, and any associated activities. This information can be invaluable for your healthcare providers in diagnosing your condition.

- Regular Follow-Up: Ensure you have regular follow-ups with your healthcare providers to monitor your symptoms and adjust your treatment plan as necessary.

Conclusion
While your symptoms may stem from a benign cause, it is essential to rule out serious conditions such as coronary artery disease or nerve compression syndromes. Given the complexity of your symptoms, a multidisciplinary approach involving cardiology, neurology, and possibly orthopedics will provide the best chance for accurate diagnosis and effective treatment. Please ensure that you communicate openly with your healthcare providers about your concerns and the progression of your symptoms.

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